How Mount Sinai Completed Epic Go-Lives in Record Time

Change Initiatives Imapct Organizational Processes

In many cases, organizational challenges come to the forefront when enterprises embark on large, complex projects requiring collaboration across teams or business units. As one of the oldest and most well-respected healthcare organizations in the United States, with over 39,000 employees, 13 free-standing joint venture centers, and 300 community clinic locations, Mount Sinai understands the magnitude and complexity of these challenges.

Accounting for Evolving Organizational Complexities

As organizations grow in size and complexity, internal structures migrate towards hierarchical, siloed teams and business units with focused areas of expertise. While these shifts are natural and necessary to support organizations of any decent size, they introduce their own set of challenges.

Streamlined processes, along with centralized and continually maintained critical documentation, facilitated Mount Sinai’s ability to meet pressing deadlines and roll out Epic to 35 new ambulatory locations in record time. This provided Mount Sinai’s teams the time required to decommission a legacy EMR system before a rigid Q4 deadline.

Exacting Deadline Requirements for Broad Solution Implementation

In March 2018, the Mount Sinai IT Project Management Office (PMO) was preparing for a 12-month Epic rollout to 86 ambulatory locations. Of these locations, 30 were using a legacy electric medical record (EMR) system, which was scheduled for decommissioning in the fourth quarter of the year. This imposed October 1st as a strict Epic implementation deadline for the first 30 locations. As well, many other project dependencies were included in the implementation initiative.

Leveraging Established PM Expertise

After successfully partnering with Mount Sinai to streamline previous Epic initiatives, T2 Tech Group (T2 Tech) recommended implementing a hybrid-Agile project management framework to improve cross-team collaboration, optimize resource utilization, standardize work processes, to facilitate completion of the rollouts on schedule. Mount Sinai saw value in this approach and engaged T2 Tech to partner with the PMO, to implement the new processes, and manage an initial round of rollouts together, before handing off the overall process to Mount Sinai.

Improving Cross-Team Collaboration

Because multiple departments were involved in each go-live, T2 Tech worked with Mount Sinai to collapse previously siloed groups into cross-functional scrum teams. The newly formed scrum teams worked through a biweekly sprint process, which streamlined planning and execution. T2 Tech and Mount Sinai focused each team on fewer rollouts over a condensed go-live schedule, which increased the pace of each rollout.

To scale the Agile sprint process across multiple teams, T2 Tech implemented a “scrum of scrums.” In these twice-weekly meetings, representatives from each team focused on improving cross-team collaboration and project performance. The scrum of scrums was a perfect venue to discuss critical cross-team dependencies, escalate roadblocks with impacts across multiple teams, and develop plans to resolve each roadblock. Ultimately, this process allowed teams to prioritize their work efficiently, based on external dependencies they would not have otherwise foreseen.

Using information gleaned from these meetings, T2 Tech and Mount Sinai continuously refined a traditional project plan, which clearly defined critical dependencies and constraints across all 86 rollouts.

Optimizing Resource Utilization

Beyond tight deadlines, Mount Sinai faced two common constraints on this project: limited resources and a constrained budget. With overlapping go-lives, allocating resources efficiently was paramount to project success. A delay on one rollout could quickly cascade into others, causing a domino effect that would imperil nonnegotiable deadlines and increase project costs.

Leveraging the benefits of cross-functional scrum teams, and gaining dependency insights from the scrum of scrums, T2 Tech and Mount Sinai efficiently coordinated work across departments. Beneficial efficiencies included performing effective resource leveling across rollouts and minimizing avoidable project delays.

Resource leveling and coordination across departments was especially beneficial during integrated testing for each rollout. During this phase, only two finance resources were available to validate and sign off on Resolute and Cadence Prelude integration across 86 rollouts. Distributing their work obligations efficiently, by staggering rollouts, was critical to meeting key deadlines and condensing project timelines.

Standardizing Work Process Across Teams

Although 86 distinct Epic rollouts were scheduled over the course of 12 months, they each shared numerous similarities. As a result, go-live teams realized significant performance benefits by sharing best practices and standardizing work processes across teams.

T2 Tech implemented an all-team sprint retrospective at the end of each two-week sprint cycle to facilitate these benefits and refine best practices. During each one-hour retrospective, the four cross-functional scrum teams assembled to review and assess opportunities for process improvements across their teams. As a result of these review meetings, the teams identified and resolved non-standard work processes, documented best practices, as well as published and maintained standard process documentation in a central repository.

This relatively simple, consistent meeting policy paid significant and measurable dividends. With clearly documented standard work processes, execution continued to improve across teams. As a bonus, onboarding new team members to the project was accelerated and optimized.

Among the improvements this approach facilitated, none were more impactful than the enhancements made to the application design, build and test processes. Previously, non-standard processes entailed creating inconsistent application results with frequent QA delays. Without these process standards, it was often hard to diagnose issues when they arose.

By sharing best practices and standardizing work processes across teams, Mount Sinai identified two unique use cases for software builds and reduced the average number of integrated testing rounds by 70%.

Providing Visibility into Project Progress

With four teams working to complete 86 Epic rollouts, Mount Sinai needed consistent visibility into project progress to eliminate unknowns and keep all teams and stakeholders on the same page. T2 Tech worked with Mount Sinai to implement a project management dashboard, as well as other summary reports, which brought clarity to this complex initiative.

T2 Tech’s project dashboard provided snapshots of progress on key milestones across all 86 rollouts. In addition, stakeholders and project teams used the dashboard to drill down into specific roadblocks and underlying project tasks which were linked to each team’s biweekly sprint plan. Quick access to roadblocks, specific project tasks, and project task owners, provided stakeholders and teams members with additional context behind high-level summaries, when needed.

Completing the Project on Schedule

T2 Tech’s primary goal was empowering Mount Sinai’s teams with effective tools and processes they could ultimately manage on their own. After successfully rolling out Epic to 35 locations, T2 Tech handed off the tools and processes to the Mount Sinai teams. Each go-live team was fully equipped to own the new project management framework and complete the remaining rollouts autonomously. Mount Sinai successfully met all key project deadlines, allowing them to decommission their legacy EMR on schedule, and rollout Epic to 35 new ambulatory locations in record time.

The remaining rollouts are on schedule for completion by March 2019 as Mount Sinai’s teams continue to engage each location implementation with proactive clarity and confidence. Upon completion, Mount Sinai will continue to leverage these processes and tools for years to come on future large-scale application implementations.

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About T2 Tech Group

We are a leader in the practical application of technology for healthcare and a range of other industries. Since our founding in 2006, we have consistently delivered quality consulting and management advisory services to executives and IT leaders. Unlike many consulting firms, we have no financial interest in vendor selection, freeing our company to focus completely on realizing client goals. Our team balances business and IT needs, uses a proven framework, can see projects from assessment to post-implementation, and practices transparency in everything we do.